Abstract Background Patients with pulmonary hypertension (PH) and chronic obstructive pulmonary disease (COPD) have an increased risk of disease exacerbation and decreased survival. We aimed to develop and validate a non‐invasive nomogram for predicting COPD associated with severe PH and a prognostic nomogram for patients with COPD and concurrent PH (COPD–PH). Methods This study included 535 patients with COPD–PH from six hospitals. A multivariate logistic regression analysis was used to analyse the risk factors for severe PH in patients with COPD and a multivariate Cox regression was used for the prognostic factors of COPD–PH. Performance was assessed using calibration, the area under the receiver operating characteristic curve and decision analysis curves. Kaplan–Meier curves were used for a survival analysis. The nomograms were developed as online network software. Results Tricuspid regurgitation velocity, right ventricular diameter, N‐terminal pro‐brain natriuretic peptide (NT‐proBNP), the red blood cell count, New York Heart Association functional class and sex were non‐invasive independent variables of severe PH in patients with COPD. These variables were used to construct a risk assessment nomogram with good discrimination. NT‐proBNP, mean pulmonary arterial pressure, partial pressure of arterial oxygen, the platelet count and albumin were independent prognostic factors for COPD–PH and were used to create a predictive nomogram of overall survival rates. Conclusions The proposed nomograms based on a large sample size of patients with COPD–PH could be used as non‐invasive clinical tools to enhance the risk assessment of severe PH in patients with COPD and for the prognosis of COPD–PH. Additionally, the online network has the potential to provide artificial intelligence‐assisted diagnosis and treatment. Highlights A multicentre study with a large sample of chronic obstructive pulmonary disease (COPD) patients diagnosed with PH through right heart catheterisation. A non‐invasive online clinical tool for assessing severe pulmonary hypertension (PH) in COPD. The first risk assessment tool was established for Chinese patients with COPD–PH.
Objective To observe the safety and clinical curative effect of trabeculectomy on continuous high intraocular pressure in primary angle closure glaucoma.Methods A retrospective analysis of 33 cases (33 eyes) (IOP≥40mmHg) in patients with high intraocular pressure performed trabeculectomy (treatment group),37 cases (37 eyes) (IOP＜40mmHg) underwent trabeculectomy (control group),were compared between the two groups of patients with preoperative and postoperative visual acuity,intraocular pressure,filtering bleb and anterior chamber formation condition.Results No choroidal fulminant hemorrhage,retinal hemorrhage,severe complications such as malignant glaucoma occurred on two groups.There were no significant differences (P ＞0.05) on intraocular pressure,visual acuity,filtering blebs,and anterior chamber on both groups.Conclusions Persistent high intraocular pressure (full medication treatment for 24-72 hour,IOP is still ≥40mmHg) of primary angle closure glaucoma patients,actively take operation therapy,can not only shorten the course of disease,but also to avoid further damage to visual function,is safe and effective.
Key words:
Persistent high intraocular pressure; Glaucoma; Trabeculectomy
Objective To compare the effect of different corneal incisions on corneal refraction after phacoemulsification and foldable intraocular lens implantation.Methods 42 eyes of 35 patients with cataract were divided into two groups randomly:group A,received temporal clear corneal incision(18 eyes of 18 cases),group B,received superior(11:00) clear corneal incision (24 eyes of 17 cases).Patients were examined preoperatively and 1 day,1 week,1 month and 3 months postoperatively by using slit-lamp microscope and corneal topography,and visual acuity also was examined.Results The visual acuity in group A was better than that in group B at 1 day postoperatively.But at 1 week,1 month,2 months postoperatively,the difference of visual acuity between two groups was not statistically significant.At 1 day preoperatively and at 1 day,1 week,1 month,2 months postoperatively,the mean astigmatism were (0.543 ± 0.264) D,(0.821 ±0.317)D,(0.732±0.320)D,(0.690±0.283)D,(0.657 ±0.233)D and (0.51 ±0.27)D in group A respectively.And at the same time points,the mean astigmatism in group B were (0.568 ± 0.243)D,(1.092 ± 0.357) D,(0.987 ± 0.257) D,(0.934 ± 0.312) D and (0.866 ± 0.371) D respectively.The mean astigmatism in group A was lower than in group B,and the difference was statistically significant (P ＜0.05).The superior incision group showed against-the-rule astigmatic changes,whereas with-the-rule astigmatism was seen in the temporal incision group.Conclusion The visual acuity in the temporal incision group was better than that in superior incision group at 1 day postoperatively.And the mean astigmatism changes in group A was lower than in group B.
Key words:
Phacoemulsification, cataract; Incision, corneal; Refraction, corneal
Abstract Background Management of inoperable chronic thromboembolic pulmonary hypertension (CTEPH) remains a clinical challenge. Currently, riociguat, a soluble guanylate-cyclase stimulator is recommended by international guidelines. More recently, balloon pulmonary angioplasty (BPA) develops as an alternative treatment for inoperable CTEPH. Method This study is a single-center randomized controlled trial. Subjects with inoperable CTEPH are randomized into either a BPA combined with riociguat or riociguat monotherapy group (2:1) and observed for 12 months after initiation of treatment. The primary endpoint is the change in pulmonary vascular resistance from baseline to 12 months after initiation of treatment. The secondary endpoints include 6-min walk distance (6MWD), WHO-FC, NT-proBNP, SF-36, and other hemodynamic parameters. Safety endpoints are analyzed too. Discussion This study aims to compare the efficacy and safety of BPA combined with riociguat and riociguat monotherapy for inoperable CTEPH. Trial registration Chinese Clinical Trial Registry ChiCTR2000032403 . Registered on 27 April 2020.
Background: Current definition of severe pulmonary hypertension due to chronic lung disease (Group 3 PH) was proposed according to the hemodynamics. However, these cutoffs are arbitrary and mainly based on expert opinion. We aimed to assess the prognostically relevant hemodynamic thresholds for severe PH in Group 3 PH.Methods: We performed a multi-center cohort study of Group 3 PH (n=466, mean age 61±12 years, 62% men) diagnosed using right heart catheterization. Baseline demographics, hemodynamics, survival, and predictor were compared in patients categorized by PH severity and lung disease etiology.Results: The major underlying diseases were chronic obstructive pulmonary disease (COPD, 56%), bronchiectasis (26%), and interstitial lung disease (ILD, 11%). A multivariable model showed that mean pulmonary arterial pressure (mPAP) ≥ 35 mmHg and cardiac index (CI) < 2.5 L/min/m2 were independent risk factors associated with increased mortality. After adjustment for age and sex, mPAP ≥ 35 mmHg or mPAP <35 mmHg with CI < 2.5 L/min/m2 indicated the presence of severe PH in patients with COPD-PH. However, mPAP ≥ 39 mmHg or mPAP < 39 mmHg with pulmonary vascular resistance ≥ 7 Wood unit as well as mPAP ≥ 33 mmHg or mPAP <33 mmHg with CI < 2.0 L/min/m2 indicated severe PH in patients with bronchiectasis and ILD, respectively.Conclusion: Diverse forms of lung diseases should have different hemodynamics criteria to define severe PH. The mPAP ≥ 35 mmHg or mPAP <35 mmHg with CI < 2.5 L/min/m2 may serve as indicators for severe PH in patients with COPD.
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